V8ASS1

• Client

• Reference

• Customer Name

• Risk Address
  Address

• Technician

• Contact Number

• Date of Assessment

  Date

• Document Number

• External photo of property - ensure this is taken with permission of the occupier

  Media

Building Fabric and Services information

• Approximate age of property (years)

• Type of property

  Select

• Number of floors

  Yes

  No

  N/A

• Provide details of main construction of external walls

  Select

• Provide details of main construction of internal walls

  Select

• Confirm details of the floor construction (Ground Floor)

  Select

• Details of Internal Woodwork

  Select

Meter Readings

• Electricity Meter (add photo where possible)

• Gas Meter (add photo where possible)

• Water Meter (add photo where possible)

Peril Information

• Damaged caused by?

  Select

• Source of water?

• Type of water?

• Approx. depth of water in millimetres?

• Duration of water within property?

• Has the cause of the incident been fixed / addressed?

  Yes

  No

• Provide a brief description of the cause of damage

• Photograph of source of damage

  Media

Site specific risk assessment

• You must provide confirmation of site specific issues noted during the visit.

• Are there any disabled residents with mobility difficulties living at the property?

  Yes

  No

• Are there any elderly / infirm residents living at the property?

  Yes

  No